Image reporting method and system

ABSTRACT

A method and system are provided to report the findings of an expert&#39;s analysis of image data. The method and system are based on a reporting system that forms the basis of an image management system that can efficiently and systematically generate image reports, facilitate data entry into searchable databases for data mining, and expedite billing and collections for the expert&#39;s services. The expert identifies a significant finding on an image and attaches a location:description code to the location of that finding in order to create a significant finding and an entry into a database. Further descriptions of that finding, such as dimensional measurements, may be automatically appended to the finding as secondary attributes. After the evaluation, the system sorts the findings in the database and presents the findings by prioritized categories. The expert edits and approves a multimedia report which may be delivered by electronic means to an end-user.

This application is a continuation of application Ser. No. 10/931,477,entitled “Image Reporting Method and System”, filed Aug. 31, 2004, nowU.S. Pat. No. 7,289,651, which in turn is a continuation of applicationSer. No. 09/990,090, filed Nov. 21, 2001, now U.S. Pat. No. 6,785,410,which in turn is a continuation-in-part of application Ser. No.09/635,515, filed Aug. 9, 2000, now U.S. Pat. No. 6,819,785, which inturn claims the benefit of priority to U.S. Provisional Application60/147,914, filed on Aug. 9, 1999, the contents of which applicationsare incorporated herein by reference.

FIELD OF THE INVENTION Background of the Invention

Image reporting as currently practiced suffers from a lack ofstandardization, consistency, accountability, and efficiency. A rootcause of these problems is the manner in which reports are generated,beginning with the lack of a standardized report format, particularly inthe medical field of radiology.

Radiologists generally review images of a body structure and dictatenarrative descriptions of their image findings followed by summarystatements. Clerical workers then transcribe the dictated statements andeither print applicable reports or enter such information into acomputerized radiology information system (RIS) and/or hospitalinformation system (HIS). As a result, the content and format ofradiology reports often vary greatly depending on the differingpreferences and styles of individual radiologists. This inconsistencyamong the radiologists' reporting styles often hinders the correlationof the reported findings with the actual images by the recipients of thereports. Variability in the reporting styles also impedes on-goingmonitoring of specific findings from different examinations on the samepatient, a task that is critical for patient care and time-consuming forradiologists. Further, traditional radiology reporting practices do notsupport data mining, a powerful tool which is useful in clinical trials,epidemiology studies, and outcomes analyses.

In addition, conventional reporting practices often provide no mechanismto allow the radiologist to account for the effective communication ofcritical report information to the recipient. Frequently, radiologistsmistakenly assume that when a report is approved and sent to a referringmedical professional, their responsibility ends. To the contrary,radiologists are often held accountable for ensuring that proper actionis taken on significant findings and are held liable for malpracticewhen proper action is not taken.

Clinicians are the typical end-users of reports from radiologists. Amajor complaint of such clinicians against radiologists and theirreporting practices involves point of service. This problem isillustrated by the following scenario: a patient receives emergency roomx-rays for an injury during the night; a radiologist interprets thex-ray images the next morning; and, following transcription, a report isfinally delivered to the emergency room physician, but typically onlyafter the patient has been treated and released. Clinicians are nowdemanding that radiologists issue reports immediately after an imagingstudy has been performed.

Hence, there is a pressing need to provide a reporting system whichoffers a standardized report format, enables consistency among reports,accounts for effective information flow, provides for quick turnaroundof information to the end-user, provides for on-going tracking ofprevious findings, and supports data mining for public healthstatistics. In addition, these needs extend beyond the field ofradiology, and include other medical fields such as pathology,histology, cardiology, dermatology, as well as other image analysisfields such as satellite imagery and photography.

SUMMARY OF THE INVENTION

The present invention relates to a new reporting method and system forreporting the findings of an expert's analysis of image data and, morespecifically, to a computer system and computer-implemented method forreporting an expert's findings relative to an analysis of image data.The method and system are based on a new structured reporting paradigm.The paradigm forms the basis of a radiology practice management systemthat can efficiently and systematically generate radiology reports,facilitate data entry into searchable databases, track findings, supportclinical trials and outcomes analyses, and expedite hospital billing andcollections. One fundamental aspect of this paradigm is that a user,e.g. an expert-radiologist, identifies a significant feature on an imageand attaches a location:description code. The location:description codecan describe what or who is present in the image, when the image wastaken, where the image was taken, and how the image was taken. Forexample, in the case of consumer digital photography, the user canattach a location:description code to a digital photograph in order tocreate a finding that indicates “Aunt Minnie: Vacationing at the beach”,or in the case of radiology can attach an anatomical:pathological codeto the location of an image feature to create a diagnostic finding. Inthe case of medical imaging, the anatomical:pathological code includesthe anatomical location followed by a pathological description.

Optionally, further attributes of that finding, such as follow-uptreatment or diagnosis recommendations, a priority descriptor,dimensional measurements (e.g., length, area, and volume), audiodescriptions, 3D rendered snapshots, etc., may be automatically appendedto the diagnostic finding as secondary attributes of the diagnosticfinding. All of this information is automatically captured in anintuitive workflow scheme transparent to the expert, and stored in adatabase. The expert may continue to identify additional diagnosticallysignificant features and create diagnostic findings in any order.

At the end of the expert's evaluation of the image(s), the system sortsthe diagnostic findings by selected or predetermined categories. In amedical field, these predetermined categories may be anatomicalcategories. The diagnostic findings are further prioritized by theseverity of the diagnosis, e.g., the priority descriptor, in order toalert the report recipient, such as a clinician. In addition, the systemmay alert the expert and display a summary of significant priorfindings, including trend data, relating to the present image analysis.The expert can edit and approve a multimedia report, which may bedelivered to an Internet server for immediate access, sent to adatabase, sent by automated voice, fax, e-mail, or wireless personaldigital assistant (PDA) (e.g. Palm™ handheld) to the clinician, or anycombination thereof. The radiologist can sign the report by electronicor voice signature. The final report presentation may be furthercustomized to satisfy the needs of the clinician.

The reporting system of the present invention is applicable to severalother image-based fields including, without limitation, pathology,histology, cardiology, dermatology, satellite imagery, and photography.

BRIEF DESCRIPTION OF THE DRAWINGS

The foregoing summary and the following detailed description of thepreferred embodiments of the present invention will be best understoodwhen read in conjunction with the appended drawings, in which:

FIG. 1 illustrates a flowchart representing a general method inaccordance with the present invention for creating an image report;

FIG. 2 illustrates a block diagram of a computer system used in thecomputer-implemented method of the present invention;

FIG. 3 illustrates a flowchart representing the steps of the process forcreating an image report;

FIG. 4 illustrates a flowchart representing steps of operation of themethod of the present invention;

FIGS. 5A and 5B illustrate the steps of annotating findings;

FIG. 6 illustrates the user-interface of the present invention in whichFIG. 6A shows a 2D viewer and FIG. 6B shows a 3D viewer;

FIGS. 7A-7C illustrate a selected report of the present invention;

FIGS. 8A-8D illustrate anatomy and pathology hot menus;

FIGS. 9A-9C illustrate the display of significant prior findings; and

FIG. 10 illustrates a report showing the tracking of a disease.

DETAILED DESCRIPTION OF THE INVENTION

A method and system are provided for generating and communicatingreports containing an expert's analysis of image data as generallydepicted in FIGS. 1 and 2. In addition, a computer-implemented methodand a computer system function to create a database of the expert'sfindings from which a report is generated and from which data mining andother analyses may be conducted. The database can be a computersearchable database and may be a relational computer database.

The method and system of the present invention are applicable to anyfield which relates to a user's analysis of images. In particular,however, the method and system of the present invention are well-suitedto image analysis found in medical applications. As such, the method andsystem of the present invention are illustrated in the accompanyingfigures and description in terms of the medical field of radiology.

The method and system are particularly well-suited to the analysis ofdigital images. However, the method and system may also be adapted foruse with analog images such as conventional x-ray films and conventionalphotographs. For example, the system can utilize a digital camera toload a digital representation of an analog image into computer memoryfor further processing.

The computerized reporting system 10 is designed to interface withexisting information systems such as a Hospital Information System (HIS)36, a Radiology Information System (RIS) 34, and a Picture Archiving andCommunication System (PACS) 32, and to conform to certain standardsincluding but not limited to the Digital Imaging and Communications inMedicine (DICOM) standard, DICOM Structured Reporting (SR) standard, orthe Radiological Society of North America's Integrating the HealthcareEnterprise (IHE) initiative. The reporting system 10 includes anexamination image storage 22, a computer console 24, a computer 26,display(s) 28, and an input device 27. For illustration purposes theinput device 27 is a three-button computer mouse, where the left andmiddle-mouse buttons (LMB, MMB) are used, for example, to manipulateimage data, and the right-mouse button (RMB) is used, for example, toidentify a new diagnostically significant feature and to start adatabase recording process. Other known input devices including LCDgraphics tablets and touch-screens may be used as well as other customdevices. For example, an intelligent view box and digital camera devicecan be used with conventional x-rays.

Bidirectional communication between the reporting system 10 and theinformation systems 32, 34, 36 allows the reporting system 10 toretrieve data from the information systems 32, 34, 36 and to updateinformation in these systems to provide the desired report generated bythe reporting system 10. For example, the reporting system 10 maydownload image data corresponding to radiological examinations ofpatients from the PACS 32, and additional information including but notlimited to patient demographics, billing information, laboratory data,and pathology reports from the HIS 36. The PACS 32 stores informationaccording to existing standards such as (DICOM). The data from the PACS32 is stored in the examination image storage 22 where it can beaccessed via the computer console 24 and computer 26 for display on thedisplay 28. Alternatively, the reporting system 10 can directly accessthe PACS images without the need for an intermediate storage device,such as image storage 22. Additionally, the reporting system 10 may belinked to communication systems such as the Internet, e-mail systems,fax, telephone, wireless communications systems such as pagers andcellphones, wireless PDA's and other communication systems.

Referring now to FIGS. 1 and 3 which illustrate the general method anddetailed process steps of the present invention, respectively,preparation of a report begins with the loading of patient data,including but not limited to billing, demographics, laboratory data,pathology reports, and image data, step 100. A file loader from computer26 searches the examination storage 22 for examination data filesavailable for analysis and displays the corresponding names of patientsin a user-interface at step 300. Upon selection of a particular patientby the radiologist, the file loader displays all of the associatedunread examination files for that patient. The radiologist selects aparticular examination file, and the file loader loads the correspondingdata into computer memory at step 302. The file loader searches throughthe image data in the selected examination and organizes the images byDICOM series (or any additional subdivisions), at step 304, prior todisplay in 2D, and optional 3D, viewers.

The file loader also displays the Current Procedural Terminology (CPT)and International Classification of Diseases (ICD) codes assigned to theselected examination and determines if they correlate at steps 102 and306. (CPT codes describe the type of radiologic examination, and ICDcodes indicate the reasons for performing a particular examination.)Proper matching of these codes are essential for reimbursement by healthcare insurers. The file loader compares the ICD and CPT codes anddisplays an alert if the codes are incompatible. The radiologistverifies the codes and enters any necessary changes. Correct assignmentof these codes at the beginning of an examination is effected by thereporting system 10 to intelligently guide the presentation ofdiagnostic code menus during the annotation process described below.Prior to the review process, an anatomical-location menu and apathology-description menu are initialized using the CPT codes at step308. For example, if the CPT code describes that the examinationencompasses a computed tomography (CT) scan of a patient's abdomen, thenthe anatomical-location menu may present specific elements such as“liver, spleen, pancreas, kidneys, etc” and not necessarily anatomicallocations corresponding to head and extremity body structures. Ofcourse, the system allows a user to access a “master index” (ordictionary) of all anatomical and pathological codes. In addition, theCPT codes guide default settings for window/level (W/L) settings, 3Dopacity map settings, and report organization/layout. Likewise, a seriesmenu is initialized to list all of the DICOM series available in theselected examination file at step 308. In addition, the file loaderretrieves existing “new paradigm” reports, i.e., those created using thepresent invention, from the patient's previous examinations and makesthem available for review during the current study.

One problem that can be encountered in the use of theanatomical-location and pathology-description menus is that theradiologist can be presented with so many menu choices that aninordinate amount of time is required to make a menu selection. Such alarge number of choices may unnecessarily increase the cost of creatinga report and may create user fatigue and increased risk for a repetitivestress injury. Accordingly, it would be desirable to limit the choicespresented to the radiologist. The system of the present inventionaddresses such problems through the use of “hot menus.”

A “hot menu” may utilize information from the CPT codes, ICD codesexisting reports which have been loaded at step 308, and/or user trendsdetermined by data mining analysis of the user's prior reports to tailorthe menus, such as the anatomical-location menu andpathology-description menu. For example, the data contained in thecurrent report and/or in any previous reports can be used to reorder thepresentation of menu choices, so that the selections used most recentlyand/or most frequently are presented earlier in the menus. For example,if the most recently selected anatomy was “spleen”, then “spleen” wouldappear at the top of the anatomical-location menu in a hot menu section,as shown in FIGS. 8A-8C. A separator, such as a row of asterisks or aline, could be placed below menu choices that are moved to a higherlevel of the menu to differentiate these choices from the choiceslocated at their standard positions within the menu. Similarly, the mostrecently or most frequently selected pathology-descriptions, asdetermined from pre-existing reports, may be presented as hot menuselections at the top of the pathology-description menu, as shown inFIG. 8D. As an alternative to a simultaneous presentation of hot menuselections with ordinary menu items, the menu may show only the recentand/or frequent selections followed by a click-able menu entry whichexpands to show the standard options when the user clicks on that entry.

One rationale for this approach is that an organ is usually evaluated inits entirety at any given time. If the right kidney contains multiplecysts, then the user may want to click on several cysts in the rightkidney in rapid succession. In such a case it would be very efficient tosee kidney appear at the top of the anatomy menu and the term cystappears at the top of the pathology menu. Likewise, it would be veryefficient to see the term “right” appear as the default in thecharacteristic field.

In addition, the anatomical and pathological menu presentations may bemodified by removing irrelevant choices from the anatomical-locationmenu or pathology-description menu. Data present in the loaded reportscan be analyzed for certain information, such as the patient's sex, andthe anatomical-location and/or pathology-description menus can bemodified appropriately. For example, the anatomical-location menuassociated with genitalia can be tailored to include only genitaliachoices appropriate to the sex of the patient. As a further example, ifa particular diagnostic procedure, as indicated by the CPT codes, isincapable of detecting a certain diagnosis, then menu choices associatedwith that diagnosis can be removed. Likewise, if information in theimage data indicates that the image data relates to the brain, then menuchoices associated with the neck, chest, abdomen, pelvis, andextremities need not be included.

After initialization of the menus, the first available image from thesorted images is displayed in a user-interface by a 2D viewer 610 asshown in FIG. 6A from which the radiologist may begin analysis of thefirst image, at steps 104 and 310. Alternately, the radiologist is freeto select a different DICOM series for evaluation from the series menu.For example, a CT or MRI examination often consists of multiple series,whereas a chest x-ray may contain only one series. Two or more seriesmay also be displayed simultaneously (e.g., supine and prone series of avirtual colonoscopy study). When a single window display is employed, a“previous” button allows the radiologist to toggle between the two mostrecently viewed series. A window/level menu, W/L, is available as partof the user-interface which lists preset window and level settings(i.e., grayscale settings) for the 2D viewer. The preset settings can bespecified in an options menu or modified using window/level sliders.

The step of displaying and rendering images, step 310, includes alteringthe display of the images in response to commands from the radiologist.For example, the radiologist can pan through a number of images in the2D viewer as the mouse is moved and the LMB is pressed, provided thatmore than one image is contained in the series. Similarly, the 2D viewercan translate (i.e., move) the image up/down and sideways when the mouseis moved and the MMB is pressed. The 2D viewer can also zoom the imagedisplay when the mouse is moved and the LMB and MMB are pressedsimultaneously. An overview button is provided in the user-interface tore-center the image in case the scene is moved out of sight. However,re-centering may be unnecessary if the ability to move or zoom an imageis restricted.

A 3D viewer is also provided in the user-interface, as shown in FIG. 6Bto render images in step 310. A 2D/3D toggle button is also included inthe user-interface to allow the radiologist to toggle between the 2D and3D viewers at step 310. In the 3D viewer, the mouse operations aresimilar to those of the 2D viewer except that pressing the LMB whilemoving the mouse causes the 3D rendered scene to rotate in space. TheLMB can also be used to control a “fly-through” mode as used in virtualendoscopy as disclosed in U.S. Pat. No. 5,782,762.

The 3D viewer incorporates techniques including render around a pointand hybrid rendering (i.e., combined volume rendering, surfacerendering, and multiplanar [MPR] display). These techniques are thesubjects of previous U.S. Pat. Nos. 5,782,762 and 5,920,319, thedisclosures of which are incorporated herein by reference. When surfacerendering and MPR are utilized, identification of new diagnosticallysignificant features, discussed below, within the 3D environment worksin the same fashion, with a RMB click. When the 3D viewer is activatedafter a diagnostic finding has been created, the volume-rendered image,e.g., a cube of CT data, (or surface-rendered or MPR image(s)) iscentered around the coordinates of the diagnostic finding.

A render-box-size menu is also provided in the user-interface to controlthe size of the volume (i.e., cube of digital data) rendered in the 3Dviewer. When changing the volume size, the 3D display automaticallyadjusts the scene to fill the screen. An opacity-map menu, Op, in the 3Dviewer permits the radiologist to control the level of transparency andgrayscale/color scale of a 3D volume rendering. In addition, the opacitymap function (or transparency) and grayscale/color map can be set by thesystem in response to the selection of an anatomical pathological codeby the radiologist, as described below. Furthermore, the system providesfunctions to manipulate the 3D object/scene including but not limited tozoom, cutting plane, and opaque cutting plane features.

As a further aspect of the display step 310, an orientation button isprovided in the user-interface to allow the radiologist to properly setthe orientation of the image data prior to 3D rendering. For example, itis assumed that the 2D first image in a CT series is the most superior(i.e., highest) image, the patient's left is on the radiologist's right,and the patient's anterior surface is facing up. If the series needs tobe reoriented, the radiologist can pan through the collection of imagesto locate the most superior image (or close to it). The radiologist thentoggles the orientation button, at which time the 2D viewer goes into anorientation mode. The radiologist freely rotates the image plane bypressing the LMB and moving the mouse until the properanterior/posterior and left/right orientation is achieved. Finally, theradiologist toggles the orientation button again to set the properorientation. The 3D viewer then automatically adjusts the image plane sothat it is orthogonal to the radiologist's viewpoint. The 3D scene canalso be automatically annotated with labeled 3D axes to assist in thevisual orientation by the radiologist.

The volume-rendered image can be manipulated in various ways (i.e.,using opacity maps, cutting planes, rotation, and fly-throughs). Asecond method for switching between the 2D and 3D viewers is to click ona 2D thumbnail image representation of a diagnostic finding (or itsappended secondary 2D and 3D images) shown in an intermediate reportdisplay, thereby recalling the last state of the 2D or 3D viewerassociated with the newly activated finding.

When transitioning between 2D and 3D viewers, the last state of eachviewer is stored. For example, the proper grayscales (or color scales)and opacity maps are applied according to the last recalled W/L or Opsettings, respectively. Similarly, when jumping to a previous finding byclicking on its thumbnail image representation, the last W/L and/or Opsettings for that finding are recalled depending on whether thethumbnail represents a 2D or 3D image. A previous button, Pr, allows theradiologist to toggle between the two most recent W/L settings or Opsettings in the 2D and 3D viewers, respectively. Alternatively, the usercan press on the LMB followed by a click of the RMB to activate the Prfunction.

Usually a radiologist compares a current examination to previousexaminations by way of old reports and/or images. A conventionalradiology report and images can be considered to represent unorganizedsets or collections of diagnostic findings. Due to the databaseorganization of diagnostic findings created by this invention, thesystem has the ability to aid in analysis of a current examination, bypresenting, at step 311, the radiologist with an organized display ofsignificant prior findings extracted from the previous reports retrievedby the file loader.

As shown in FIG. 9A, the prior findings may be divided into “SignificantPrior Findings” and “All Prior Findings”, as shown in FIG. 9A. Forexample, the finding for the “Liver” shown in “All Prior Findings”section of the report does not appear in the “Significant PriorFindings” section of the report. This omission of the liver may be dueto the fact that the “Liver” is unrelated to the “Heart,” “Lung,” or“Skeleton” of the 9/1/1 procedure or the CPT code for the 9/1/1procedure. Another reason for the omission may be that the “Liver”finding was not designated with a sufficient level of significance. Theprior findings may be sorted by a designated priority code, anatomy, ormodality (e.g., x-ray). In addition, the presentation of prior findingsmay include stored images associated with the findings, as shown inFIGS. 9B and 9C. In the case where the prior findings are part of ahorizontally linked series, described below, the radiologist may bepresented with a trend report which shows a chronological tracking of afinding, such as tumor size, as shown in FIG. 10.

During review of an image using the viewers as described above, theradiologist searches for any diagnostically significant image features.When the radiologist locates a diagnostically significant feature, theradiologist begins the process of recording a diagnostic finding atsteps 106 and 312. The process of recording a diagnostic finding beginswith positioning the cursor over the location of the feature on thedigital image and clicking the RMB at step 312. Alternatively, whenapplying the invention to conventional x-rays or images, a digitalcamera device can be pointed at an image finding, and a representativedigital image can be recorded. Alternatively, the radiologist may pointat the feature by using an intelligent view box. Clicking on the RMBstores the image coordinates, for example DICOM coordinates, and animage number corresponding to the cursor location in a database. Tocomplete the definition of a diagnostic finding, an anatomicalpathological code and, optionally, secondary attributes are assigned tothe image coordinates and automatically stored in the database. Theanatomical code identifies the anatomical location within the body, andthe pathological code describes the radiologic pathology of theidentified image feature. The anatomical:pathological codes may bederived from a predefined lexicon, such as the American College ofRadiology (ACR) Index of Radiological Diagnoses or SystematizedNomenclature of Medicine (SNOMED). The secondary attributes provideadditional descriptions of the finding and include, for exampledistance, area and volume measurements, characteristics and status ofthe finding, as well as multimedia information such as audiodescriptions, 3D snapshots, and 3D illustrated movies.

In response to the RMB click the reporting system can automaticallydisplay a pop-up anatomical-location menu at step 314. Theanatomical-location menu may consist of a cascading list of anatomicallocation codes that have been customized based on the previouslyverified CPT and ICD codes; i.e., the anatomical-location menu presentsonly the anatomical organs associated with a particular radiologicexamination. The cascading anatomical-location menu provides greaterlevels of detail of the finding's anatomical location with eachcascading level presented. For example, a first level might specify“Colon”, and a second level “Sigmoid Colon”. Upon selection of ananatomical code, the reporting system displays a cascadingpathology-code menu, at step 316, which displays a cascading list ofpathology codes that correspond to the selected anatomical location. Forexample, a first level of the pathology-code menu might specify“Neoplasm”, the second “Benign Neoplasm”, and the third “Polyp”. Ananatomical:pathological code must be assigned to any unlabeled findingsprior to final report approval; otherwise, these findings are labeledwith the default “unknown location:unknown pathology” or any combinationthereof. If no abnormal findings are entered for a particular anatomy(i.e., for anatomical organs contained within the scope of anexamination described by a CPT code), then a “Normal” default may beapplied as a summary diagnosis for that organ. When a diagnostic findinghas an indeterminate etiology, the radiologist my assign a list ofdiagnostic possibilities, representing a differential diagnosis, assecondary attributes of that finding. Alternately, the reporting system10 can incorporate voice activated control and natural languageprocessing in conjunction with or instead of the pop-up annotationmenus, i.e. the anatomical-location and pathological-description menus.The radiologist could speak “Sigmoid Colon Polyp” to achieve the sameresult as using the annotation menus.

As each diagnostic finding is created, a representative thumbnail image620, as shown in FIG. 6, may be displayed on the right side of the 2Dand 3D viewers for immediate presentation and recall, and the thumbnailimages later may be incorporated into the final report. Alternately, thereport with thumbnail images can be displayed on a second independentmonitor as it is being created. The above method for entering ananatomical:pathological code is denoted “click and label”. Twoalternative methods are also possible for performing steps 314 and 316.

The first alternative method, “click-pause-label”, allows theradiologist to postpone assignment of an anatomical:pathological codeuntil sometime later during the analysis of the finding. In this case,the radiologist must deliberately press anatomy-location and/orpathology-description button, An and Pa, on the 2D or 3D viewer, asshown in FIG. 6, to subsequently activate the corresponding pull-down(as opposed to pop-up menu) annotation menu. The second alternativemethod, “click-click-click and label-label-label”, allows theradiologist to annotate the diagnostic findings during final reportediting. A more detailed description of these two methods is discussedbelow in conjunction with the method of operation of the reportingsystem.

The method of entering and annotating diagnostic findings is not limitedto computer pop-up and pull-down menus containing preselectedterminology. Keyboard, voice recognition, macros, and natural languageprocessing are available to enter diagnostic findings and secondaryattributes.

After assignment of the anatomical:pathological codes, secondaryattributes may added at step 318 to embellish or support the diagnosis.As shown in FIG. 6, the user-interface 600 of the reporting system 10includes various options for adding secondary attributes. A chart of thesymbols used on FIG. 6 are set forth in the following chart. The optionsmay be available in one or more of three major subsystems of theinvention, as shown in the third column of the chart. The three majorsubsystems include image analysis (IA), report generation (RG), andreport viewing (RV). The image analysis subsystem includes the imageloading, step 100, and a display of the images, step 104. The reportgeneration subsystem includes the recording of the findings, step 106,annotation of findings, step 108, and creation of links/groups, step110. The report review function includes algorithms associated with step112.

An Annotation menu listing ACR RG Dx codes Vo Volume measurement buttonIA Ch Characteristic button RG Di Distance measurement button IA Ar Areameasurement button IA Au Audio record button RG Pt Priority button RG RmRecommendation button RG Sn Snapshot button IA & RG Mo Movie button IA &RG W/L Window/Level presets menu IA Orientation button IA Overviewbutton IA Pr Previous window/level setting IA toggle button 2D/3D 2D/3Dviewer toggle button IA Cr Cursor on/off toggle button IA Series Seriesmenu IA MPR Multi-planar button IA Surf Surface rendering button IA OpOpacity map presets menu IA ₆₄ Render box size menu IA

Opaque cutting plane toggle IA button

For example, a characteristics button, Ch, is included to activate amenu of descriptive attributes that enhance a specific diagnostic codeset, (i.e., anatomy:pathology code combination). For example,“liver:metastatic neoplasm from colon” (ACR diagnostic code 761.3375)can be further characterized with the number of lesions (i.e., single ormultiple).

A distance-measurement button, Di, is included in the user-interface ofthe reporting system 10 to permit the radiologist to measure a findingin the 2D or 3D viewer with any number of diameters. Similarly, anarea-measurement button, Ar, allows the radiologist to define aregion-of-interest (ROI) from which the cross-sectional area, mean pixelor voxel value (depending on whether the measurement is made on a 2D or3D image, respectively), and standard deviation of pixel or voxel valuesin that region can be calculated. Measurements automatically becomesecondary attributes of the active diagnostic finding and are stored inthe database associated with the diagnostic finding. Additionally, avolume-measurement button, Vo, is provided to permit the radiologist todefine a volume-of-interest VOI. The reporting system 10 can create theVOI by 3D segmentation means, as disclosed in U.S. Pat. Nos. 5,782,762,5,920,319, and 6,083,162, each of which are incorporated herein byreference. A volume measurement calculated from the VOI may be added asa secondary attribute.

The reporting system also permits the assignment of both priority levelsand recommendations to a finding. A priority button, Pt, permits theradiologist to add a certain level of significance to a diagnosticfinding at step 319. For example, the priority level may be selectedfrom a predefined list containing entries such as “(1)Life-Threatening”, “(2) Significant”, “(3) Index”, “(4) Repetitive”, and“(5) Incidental”, and such entries may be presented as part of anysubsequent report, as shown in FIG. 9B. One of more of priority levelsmay be combined, such as “Life-Threatening” and “Index”. An “Index”priority denotes a trackable finding, as described below. The prioritylevel can also be used to generate the production of the “SignificantPrior Findings” and “All Prior Findings” as shown in FIG. 9A. Forexample, the “Significant Findings” may include prior findingsdesignated with a priority of level of “Life-Threatening” or“Significant.” Hence a selected priority level or set of levels can beused to select the findings for inclusion as “Significant PriorFindings” in the report of FIG. 9A. A recommendation button, Rm, can beused to label a “Sigmoid Colon: Polyp” diagnostic code with arecommendation such as “Recommend colonoscopy for polyp removal.” Bydefault, the reporting system 10 does not assign any particular priorityor recommendation to a diagnostic finding; however, certain diagnosticcodes may be assigned default priority and recommendation codes whichmay be changed by the radiologist.

An audio button, Au, is included in the user-interface to allow theradiologist to dictate a verbal description of a diagnostic finding, andthat audio file becomes a secondary attribute of the finding. The audiofile can be saved in the final report unchanged, or it can betranscribed to text by a typist or a voice recognition system.

A snapshot button, Sn, in the user-interface allows the radiologist torecord any number of additional 2D and 3D images as secondary attributesof a diagnostic finding. For example, a “colon:polyp” diagnostic findingcould be supported by additional 3D snapshots of the polyp. In the caseof “spine:arthritis” which is seen over a large portion of the skeleton,a single diagnostic finding can be created to establish the diagnosis,and additional snapshots of other sites of the disease can support thediagnosis. Alternatively, creating multiple individual diagnosticfindings documenting arthritis could achieve the same result.Additionally, the recording system provides the ability to place amarking symbol in the 2D or 3D images indicating the location of theselected feature. The snapshot function also records the location of themarking symbol visible within the 2D or 3D viewer, as well as the stateof the 2D or 3D viewer at which time the Sn button was pressed.

A movie button, Mo, functions in a similar manner by appending cineclips of moving 2D or 3D images, including active annotations and voicedescriptions. The active annotations can take the form of freehandnotations “drawn” over the 2D or 3D images during recording of the cineclip. The drawn freehand notations can be similar to “chalkboard-style”markings used by television commentators to diagram and analyze footballplays.

To assist radiologists in establishing a diagnosis, the annotation menusmay also provide links to reference materials and example images relatedto each potential diagnostic code set combination. The annotation menusmay include options to undo accidental RMB clicks. The reporting system10 also permits the radiologist to recall the annotation menus toreassign a diagnostic code to a particular finding if the diagnosis isrevised during the evaluation process.

The reporting system 10 may also perform computerized diagnoses at step320. For example, computer-assisted polyp detection (CAPD), as disclosedin U.S. Pat. No. 5,920,319, can be integrated with the system so thatCAPD-identified polyps can be automatically correlated withradiologist-defined polyps by correlating the proximity (i.e., Euclideandistances) of image finding coordinates. The identified diagnosticfindings can be used to support advanced applications, such as thecreation of “polyp maps” for subsequent endoscopic or surgical guidance.A polyp map consists of a 3D-rendered colon with highlighted polyplocations.

Another example of an advanced application that this reporting systemsupports is a Transbronchial Needle Aspiration (TBNA) targeting scheme.The TBNA application uses the stored data in the reporting system 10 toautomatically construct airway models and lymph node targets (i.e.,surface-rendered models of the anatomy generated using the respectivefinding coordinates). TBNA is a bronchoscopy technique that permits aneedle biopsy of suspicious mediastinal lymph nodes. Thetracheobronchial tree and lymph nodes are defined by their diagnosticfinding coordinates, respectively, and are assigned secondary attributesby the radiologist to indicate the TBNA lymph nodes as targets. Furtherrefinement of the lymph node targets (i.e., modeling lymph nodes asspherical or ellipsoid objects) can use the distance, area, and volumemeasurements that are generated as secondary attributes of those lymphnodes.

After the review of the image(s) is deemed complete, the report displayis presented for the radiologist to review at step 332. The reportdisplay is invoked by pressing a report button in the user-interface toactivate the report display. Alternately, when using a two-monitorsystem or a wide monitor display, the report can be shown simultaneouslyas it is being generated. The reporting system 10 sorts the diagnosticfindings according to anatomical categories, with high priority findingsplaced at the top of each category. The reporting system 10 can alsoorder the findings by priority levels, irrespective of anatomicalcategories, or by chronology, indicating the order in which the findingswere recorded by the radiologist. The reporting system 10 highlightseach high-priority finding (e.g., life-threatening and significantfindings, levels 1 & 2) with color-enhanced text. The radiologist editsthe final report as necessary, including linking redundant findings atstep 324.

A powerful feature of the paradigm's report format and databasestructure is the ability to link and track diagnostic findings withinthe same examination (i.e., vertical linking) and across serialexaminations (i.e., horizontal linking). For example, a CT examinationgenerally consists of a hierarchy of series/acquisitions/images. Adiagnostic finding identified on an image within one series may also beseen in another series of the same examination. The reporting system 10provides the ability to vertically link (group or combine) suchdiagnostic findings within its database. In one implementation, theradiologist “drags and drops” a finding onto a matching finding in thereport display to achieve linking, and the “dropped” finding becomes asubset of the primary finding. Alternatively, the reporting system 10could perform linking via a command-line interface, voice-activatedcontrol, or graphical interface, i.e., highlight user-selected relatedfindings and press a “Group” button. The purpose of vertical linking isto manage redundancy of report information.

Similarly, the reporting system 10 provides horizontal linking as ameans to track and monitor a diagnostic finding over time and acrossvarious imaging modalities. In horizontal linking, diagnostic findingscan be “dragged and dropped” across reports. In this case, thediagnostic findings exist independently in their respective reports anddo not necessarily become subsets of other findings. Horizontal linkingprovides a means to efficiently analyze a particular diagnostic findingover time (i.e., disease tracking). As illustrated in the report of FIG.10, the size of a tumor can be automatically presented in graphicalformat as size versus time. The size of the tumor can be selectivelymeasured as an axial distance, area, volume, or other function.

An extension of “linking” is “compositing.” A group of image findings(e.g., pleura:pleural effusion, heart:cardiomegaly, lung:pulmonaryedema) can be composited (i.e., linked or grouped) by the radiologist orby an artificial intelligence (Al) program to yield a cumulativediagnosis of “congestive heart failure.” Similarly, the radiologist oran AI program can composite other clinical information (e.g., laboratoryvalues or pathology reports) to support and establish a diagnosis. Forexample, specific findings may be grouped by use of a “Group” buttonfollowed by selection of specific annotations to describe the groupedset of findings.

The reporting system 10 also allows for the automatic incorporation ofrepetitive findings (i.e., designated as a “Repetitive finding” usingthe above priority assignment feature) from previous reports into a newreport (e.g., evidence of prior gallbladder surgery). If a previousreport contains a “trackable” finding (i.e., designated as an “Indexfinding” using the above priority assignment feature), that previousfinding is brought to the attention of the radiologist. In this case,the trackable finding can be linked horizontally across reports, and thetemporal progression of this finding, as shown in FIG. 10, can beobserved in a specialized viewer.

The report display also includes a suspend-resume button for suspendingor resuming an examination in case the radiologist is interrupted duringthe review. Upon completion of the report, the reporting system 10stores and sends the final report, as shown in FIGS. 7A-C, at step 326.The reporting system 10 may issue the report by any combination oftelephone, fax, pager, e-mail, or wireless PDA and may include returnreceipt verification. The automated sending and receipt verificationallows the radiologist to quickly communicate his or her findings andtrack this communication. Along with the prioritized and highlightedpresentation of the most significant findings, the automated sendingfeature of the reporting system 10 helps to fulfill the radiologist'sduty for timely communication of results and follow-up on the findings.

The reporting system also supports “real-time dynamic radiology.” Eachdiagnostic finding is annotated with a timestamp. After an initialreport is “signed off,” any future changes to the report can be recordedas a history of the report. Any subsequent significant changes can beautomatically communicated to a clinician and verified upon theirreceipt.

The reporting system 10 monitors how the radiologist reviews anexamination. The final report can also indicate how much time aradiologist spends reviewing an exam, number of findings, and averagetime per finding. Statistics, including total review time, time perfinding, number of findings, and diagnostic accuracy, are compiledduring a review session and are reported as needed. This feature createsa utilization management and quality assurance measure that is appealingto the Health Care Financing Administration (HCFA) and healthmaintenance organizations (HMOs). In addition, physician profiling maybe employed for utilization management to review the ordering practicesof referring physicians.

The final report can also be automatically translated into a foreignlanguage using the standardized lexicon of anatomical:pathological codesand simple lookup tables.

Healthcare organizations further benefit from the automation andefficiency of the system. In particular, billing speed and accuracy areincreased. Billing requires matching of ICD and CPT codes, a task thatcurrently requires highly-trained personnel to decipher radiologyreports and verify proper code assignments. Incorrect coding results indenied or delayed reimbursement by insurers. However, the presentreporting system automates the process and allows radiologists toapprove the coding process.

The method of operation is best illustrated by its application in thefield of radiology as shown in FIG. 4. Upon starting the softwareprogram, the radiologist signs in, with either a password or voicesignature or any other security measure, to begin the evaluation at step400. Secure sign-in protects access to the database and validates theidentity of the radiologist generating the report. The file loaderdisplays a work list of patients whose examination studies areaccessible. The radiologist selects the name of a patient at step 402,and the file loader displays all of the associated unread examinationfiles. The radiologist selects a particular examination file, and thatexamination file is loaded into computer memory.

The file loader displays the CPT and ICD codes assigned to a particularexamination. This information can be obtained from the HIS 36 or enteredmanually. The radiologist verifies the CPT and ICD codes and makes anynecessary changes at step 404. Correct assignment of the CPT and ICDcodes by the radiologist is essential for electronic billing andexpedited reimbursement by insurers.

After validation of the CPT and ICD codes, the radiologist beginsanalysis of the first image presented in the 2D viewer or selects analternate image, at step 406, from the series menu which lists all ofthe images or sets of images (i.e., series) in a patient exam availablefor review. The radiologist may change the displayed image in order tolocate diagnostically significant features in other images at step 408.For example, the radiologist may press the LMB while moving the mouse topan through multiple images in the 2D viewer (provided that more thanone image is contained in the series). The radiologist may alsotranslate the displayed image up, down, and sideways by pressing the MMBwhile moving the mouse. The radiologist may also zoom the displayedimage by pressing the LMB and MMB simultaneously while moving the mouse.In the 3D viewer, the mouse operations are similar except that pressingthe LMB while moving the mouse causes the 3D rendered scene to rotate inspace or to guide a “fly-through.” Alternatively, multiple images orseries can be displayed simultaneously in separate windows in the imageanalysis (IA) viewer.

To aid in the identification of diagnostically significant features, theradiologist may toggle between 2D and 3D viewers by pressing the 2D/3Dtoggle button as shown in FIG. 6. When the 3D viewer is initiallyactivated, a volume-rendered image centered around the coordinates ofthe identified feature is created (i.e., a cube of CT data isvolume-rendered). The radiologist may adjust the size of the volume(i.e., cube of digital data) that is rendered in the 3D viewer via therender-box-size menu. The radiologist may further adjust thevolume-rendered image in various ways, such as using opacity maps, cutplanes, and rotation. MPR and surface rendering can also be activated inthe 3D viewer.

When the radiologist toggles between 2D and 3D viewers, the last stateof each viewer is recalled. The radiologist may also toggle between the3D and 2D viewers by clicking on a primary 2D thumbnail imagerepresentation of a diagnostic finding (or its supporting secondary 2Dand 3D thumbnails), thereby recalling the last state of the 2D or 3Dviewer associated with the activated finding. The cursor position andlocation of any marking symbols in the display are recalled as part ofthe last state of the viewer. The 2D or 3D viewer then enters an editmode, during which the radiologist can append additional secondaryattributes to the activated diagnostic finding, and these aresubsequently stored in proper locations within the database.

The radiologist can also set the orientation of the image data prior toimage analysis. If an image or image series needs to be reoriented, theradiologist pans through the volume of images to locate the mostsuperior image (or close to it). Then, the radiologist toggles theorientation button, at which time the viewer goes into an orientationmode. The radiologist rotates the image plane by pressing the LMB andmoving the mouse until the proper anterior/posterior and left/rightorientation is achieved. Finally, the radiologist toggles theorientation button again to set the proper orientation. The viewerautomatically adjusts the 2D image plane so that it is orthogonal to theradiologist's viewpoint.

The radiologist has further control over the display of the images suchas W/L (i.e., grayscale or color scale) and 3D opacity maps settings.The radiologist may toggle between the two most recent W/L settings orOp settings in the 2D and 3D viewers by pressing the previous button,Pr, as shown in FIG. 6, or simultaneously pressing the LMB and RMB.Additionally, the radiologist may toggle a visible cursor on and off bypressing a cursor-toggle button, Cr, as shown in FIG. 6, to indicate thelocation of a finding in both the 2D and 3D viewers. By pressing theoverview button, the radiologist re-centers a 2D or 3D volume-renderedimage in case the scene is moved out of sight.

When the radiologist locates a diagnostically significant feature, theradiologist positions the cursor over the location of the feature on thedigital image and clicks the RMB to mark the feature at step 410.Clicking on the RMB stores the image coordinates and image numbercorresponding to the cursor location in database. To complete thedefinition of a diagnostic finding, the radiologist annotates the point(location) by assigning an anatomical:pathological code and optionallyassigning secondary attributes at steps 412 and 414. This annotation isstored in the database, and it may also be displayed as a text overlayon the image.

The radiologist selects an anatomical:pathological code from apredefined lexicon, such as the ACR Index of Radiological Diagnoses orSNOMED or a custom designed lexicon, to create a diagnostic finding. Aseach diagnostic finding is created, a representative thumbnail image 620may be displayed on the right side of the 2D and 3D viewers, or in aseparate display, for immediate review and recall, and the thumbnailimages later may be incorporated into the final report as shown in FIGS.7B and 7C.

The radiologist enters the anatomical:pathological code by one ofseveral modes. In a first mode, “click and label”, cascading pop-upannotation menus are presented to the radiologist immediately after afeature is marked by an RMB click at step 500 of FIG. 5A. Theradiologist selects an appropriate anatomical location description fromthe anatomical-location menu at step 502. For example, the radiologistmay select Colon: Sigmoid colon. After the selection, the radiologistselects the pathological description from the pathology-description menuat step 502. For example, the radiologist may select Neoplasm:BenignNeoplasm:Polyp. A secondary attribute may then be assigned at step 504.

In a second mode, “click-click-click and label-label-label”, theradiologist identifies all the diagnostically significant features firstand subsequently annotates the features with diagnostic codes andsecondary attributes. As shown in FIG. 5B, the radiologist marks adesignated feature at step 550 and then proceeds to mark successivefeatures by repeating step 550. After all desired features are marked,the radiologist assigns a diagnostic code to each marked feature byassigning an anatomical code at step 552 and a pathological code at step554. Secondary attributes are assigned at step 556 either following themarking of a feature at step 550 or the assigning of anatomical andpathological codes at steps 552 and 554. The radiologist must assign adiagnostic code to any unlabeled findings prior to final reportapproval; otherwise, these findings may be labeled with a default“Unknown Location:Unknown Pathology.” Additionally, the radiologist mayrecall the annotation menus to reassign an anatomical:pathological codeto a particular finding if the diagnosis needs to be revised during theevaluation process.

The radiologist may also assign secondary attributes to embellish orsupport a diagnostic finding at step 414, but secondary attributes arenot required for establishing a diagnostic finding. The radiologist mayenter descriptive characteristics, dimensional measurements, audiodescriptions, and specific snapshots of particular views of theidentified finding as secondary attributes. For example, the radiologistmay add descriptive characteristics that enhance a specific diagnosticcode set from a characteristics menu of descriptive characteristics.

The radiologist may measure one or more dimensions of a finding, forexample, a diameter of an identified feature in the 2D or 3D image. Theradiologist activates the distance measuring function by pressing thedistance-measurement button, Di, as shown in FIG. 6. The radiologistmeasures the distance by clicking on first and second object pointswhich span the characteristic length. Similarly, the radiologist maymeasure the area of an identified feature by pressing thearea-measurement button, Ar, as shown in FIG. 6 and defining aregion-of-interest (ROI) using the input device 27. The cross-sectionalarea, mean pixel or voxel value, and standard deviation of pixel orvoxel values in the ROI can be calculated. The radiologist may also adda volume-measurement as a secondary attribute by pressing thevolume-measurement button, Vo, as shown in FIG. 6.

As part of step 414, the radiologist may also add a priority level andrecommendation to the diagnostic finding by pressing the prioritybutton, Pt, or recommendation button, Rm, respectively, as shown in FIG.6. In addition, the radiologist may append a verbal description of thediagnostic finding in the form of an audio file. To add a verbaldescription the radiologist presses the audio button, Au, as shown inFIG. 6 to initiate recording and then dictates a verbal description ofthe diagnostic finding. The radiologist presses the audio button againto stop recording, and an audio file of the verbal description is storedin the database attached to the finding. Audio files can be attached to“grouped or linked” findings or attached to individual snapshot imagesor movies. Audio files may be edited and/or appended with additionalaudio clips.

Additionally, the radiologist may record snapshots of any of thedisplayed 2D and 3D images as a secondary attribute by pressing thesnapshot button, Sn, as shown in FIG. 6. For example, the radiologistmay record any number of additional images showing differing views of aparticular diagnostically significant feature. For example, a“colon:polyp” diagnostic finding could be supported by additional 3Dsnapshots of the polyp. The radiologist may also append cine clips ofmoving 2D or 3D images (including audio and active annotations) as asecondary attributes in a manner similar to recording snapshots bypressing the movie button, Mo, as shown in FIG. 6. Pressing of the moviebutton starts and stops the recording of the cine clip.

Prior to final report review, the radiologist may also invokecomputer-aided location and analysis of diagnostically significantfeatures, at step 416, whereby the system automatically identifies anddiagnoses suspicious image features. For example, the radiologist canreview polyps found by the CAPD that were not previously identified bythe radiologist.

After the radiologist's review is deemed complete, the radiologistclicks a report button on the bottom of either the 2D or 3D viewer asshown in FIG. 6 to activate the report display at step 418. Alternately,the report can be generated and simultaneously displayed on a secondmonitor while the diagnostically significant findings are being locatedand annotated. The diagnostic findings are sorted according toanatomical categories and priorities, with high priority findings beingplaced at the top of each category. Each high-priority finding ishighlighted with color-enhanced text. The sorting and highlighting ofthe diagnostic findings alerts the end-user to the most significantdiagnostic findings. Alternatively, the findings may be sorted bychronological order.

The radiologist edits the final report as necessary, including linkingredundant findings at step 420. This process could also be automatedwith artificial intelligence and detaining algorithms. The step ofcreating links, step 420, may be performed before or after the step ofreviewing the report, step 418, as depicted in FIG. 1, where the step ofcreating the links, step 110, occurs prior to the step of reviewing thereport, step 112. In one implementation of vertical linking, theradiologist “drags and drops” a finding onto a matching finding in thesame report display, and the “dropped” finding becomes a subset of theprimary finding. Alternatively, the radiologist can form links via acommand-line interface or voice-activated commands (control). Similarly,the radiologist may assign horizontal linking to track and monitor adiagnostic finding over time and across various imaging modalities(i.e., disease tracking). In horizontal linking, diagnostic findings canbe “dragged and dropped” across reports in a similar fashion.

The radiologist may also composite a group of image findings to yield adiagnosis as illustrated above for “congestive heart failure.” In thisprocess, the radiologist or an AI program can link/group/compositeadditional clinical information (e.g., laboratory and pathology reportvalues) to support a diagnosis.

The radiologist further reviews any repetitive diagnostic findings fromprevious reports which are brought to the attention of the radiologistby the system. If a previous report contains a repetitive diagnosticfinding (e.g., evidence of prior gallbladder surgery), that finding ispresented to the radiologist for automatic incorporation into the newreport. If a previous report contains a “trackable” diagnostic finding(e.g., index lymph node measurement), the radiologist can link thetrackable diagnostic findings horizontally across reports, and thetemporal progression of this diagnostic finding can be observed in aspecialized viewer.

The radiologist can suspend an examination for later resumption bypressing the suspend-resume button during the review. Upon completion ofthe report the radiologist instructs the system to send the report tothe end-users (e.g., clinicians) at step 422. Additionally, the end-usercan access the report via a Web server after the report has been posted.As noted above, the report may be sent by a combination of telephone,fax, pager, e-mail, or wireless PDA and may include return receiptverification. The automated sending and receipt verification allows theradiologist to quickly communicate his or her findings and verify thiscommunication.

End-users receiving the radiologist's report can customize the displayof the information to best suit their needs. For example, when thereporting system is integrated with a PACS and/or HIS system, theclinician can click on a thumbnail image in the final report to accessthe original PACS or HIS image data. For convenience the PAC or HISimage data may be displayed on one screen or display terminal while thereport data is displayed on a separate screen or display terminal.Additionally, the reporting system can automatically translate theradiologist's report into a different language for the end-user. Thestandardized lexicon of diagnostic findings supports rapid translationof reports to foreign languages by employing translation look-up tables.

The reporting system of the present invention has further applicationbeyond the preparation and delivery of reports. The ability of thereporting system to enter diagnostic findings into searchable databasesreadily supports data mining for clinical trials, epidemiology studies,and outcomes analyses.

Additionally, the reporting paradigm supports radiologic training. Forexample, a radiology resident can issue a preliminary report indicatinghis or her findings, and the preliminary report can later be modified byan attending radiologist to indicate any corrections. In the lattercase, the system automatically informs the referring clinician of anysignificant changes. The history of report changes can be recorded witheach finding (or changed finding) having a timestamp. The reportingscheme also supports standardized testing (e.g., replacement of theAmerican Board of Radiology's Oral Board examination) by objectivelymeasuring a student's performance. Such an objective performance measurecould also assist in comparing a radiologist's performance to that of anon-radiologist.

These and other advantages of the present invention will be apparent tothose skilled in the art from the foregoing specification. Accordingly,it will be recognized by those skilled in the art that changes ormodifications may be made to the above-described embodiments withoutdeparting from the broad inventive concepts of the invention. Forexample, while the above invention has been illustrated in terms of itsapplication to the field of radiology, the invention is equallyapplicable to other fields of medicine as well as other image analysisfields such as satellite imagery and photography. It should therefore beunderstood that this invention is not limited to the particularembodiments described herein, but is intended to include all changes andmodifications that are within the scope and spirit of the invention asset forth in the claims.

1. A computer-implemented method for analysis of an image from a seriesof images formed in a radiological examination of a subject comprisingthe steps of: retrieving image data comprising the image and anexamination-code assigned to the radiological examination identifyingthe type of radiological examination, presenting the image to a user foranalysis, to select and identify a feature of interest therein,receiving an identification of the selected feature from an input deviceto selectively mark a location on the image representing the selectedfeature, recording image coordinates of the selected feature within theimage, generating a list of description-codes and a list oflocation-codes and a series menu using the examination-code, presentingthe list of description-codes and the list of location-codes and theseries menu to the user, the series menu listing the images or series ofimages formed in the radiological examination which are available forreview by the user, receiving a description-code associated with theselected feature to describe an attribute of the feature, thedescription-code being selected by the user from the list ofdescription-codes, receiving a location-code which describes thelocation of the selected feature within an object depicted in the image,the location-code being selected by the user from the list oflocation-codes, and creating an image finding of the selected featurecomprising the recorded coordinates, the selected location-code and theselected description-code.